Calcific Tendonitis

Epidemiology

  • Common
  • Men around 40 years typically

Aetiology

  • Unknown for sure
  • Reactive (favoured) or degenerative pathologies suggested
  • 3 Phases
    1. Pre-Calcific
    2. Calcific
      • Formative
      • Resorptive
    3. Post-Calcific
  • Almost always in Supraspinatus tendon
  • 1.5 cm from cuff insertion
  • Calcium never in contact with bone
  • May cause impingement if large

Pre-Calcific Phase

  • Site of calcification in tendon undergoes fibrocartilaginous metaplasia
  • Pain-free
  • No XR features

Calcific Phase

Formative

  • Calcium deposition occurs within the tendon
  • Hard & Chalk-like at this stage
  • Mild or no pain
  • Homogeneous on X-ray

Resorptive

  • Phagocytic resorption spontaneously begins
  • Very painful
  • Toothpaste-like consistency
  • Heterogeneous or fragmented on X-ray

Post-Calcific Phase

  • Type 3 collagen slowly replaced by normal Type 1 collagen
  • Pain subsides
  • Function returns
  • X-ray calcification becomes difficult to see

Diagnosis

  • History and X-ray typical
  • Cuff power intact but difficult to assess due to pain

Management

Non-Operative (preferred as it will resolve)

  • Injection for impingement, NSAIDs, Physiotherapy

Operative

  • Indications
    • Debilitating pain
    • Prolonged course
    • Impingement
  • Techniques
    • USS-guided needling
    • ECSWT (some evidence but not high quality)
    • Arthroscopic needling
    • Cuff repair is almost never required after needling and lavage
    • Open excision
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